- Neurological:
-
two point discrimination:
- used to test sensory innervation of the digits in adult patients, where as, the ability of skin to wrinkle (when placed in water)
is used to test sensation in children;
- normal values:
- thumb: 2.5-5 mm; index: 3-5 mm; other digits: 4-6
mm and base of the palmar aspect of the digits: 5-6
mm
- thenar and hypothenar eminences: 5-9
mm,
dorsal aspect of the digits: 6-9
mm, mid-palm region: 11
mm, dorsal aspect of the hand: 7-12 mm
- reference:
-
A study of the relative responsiveness of five sensibility tests for assessment of recovery after median nerve injury and repair.
-
The two-point discrimination test - time for a re-appraisal?
-
tinel's sign:
- may be positive w/ nerve compression;
- may be used to following healing of nerve repair;
-
brachial plexus - exam:
-
median (
AIN,
high median lesions,
low median lesions);
-
radial (
PIN):
-
ulnar (
high ulnar lesions,
low ulnar lesions);
- Vascular: (
diff dx)
- see:
vascular repair technique:
- allen test of wrist:
radial artery,
superficial palmar arch,
ulnar artery);
- allen test of common digital artery
- allen test of individual fingers
- Joint ROM:
- functional ROM for wrist flexion and extension is 65 deg;
finger:
mp/f/ext
pip/
f/ext
dip/
f/
ext
90
0-110
80
thumb: IP/
flex/
ext
mp/f/ext
90 to -20
50-0
wrist: flex
ext
r/dev.
u/dv.
pronation
supination
75
70
25
45
60
60
- Test for Tendon Contractures:
- extrinsic contractures: note whether the patient can fully flex fingers w/ wrist extended;
-
bunnel littler test:
- MP held in mild extension, attempt to flex PIP joint;
- if joint can't flex, either intrinsics are tight or capsule contracture
- Motor and Tendon Exam:
-
tendon injuries of the hand
- FDP and FDS tendons to each finger are individually tested for strength and excursion;
- Tenderness:
-
ulnar sided wrist pain:
-
radial and snuff box tenderness
- Misc:
-
triquetrolunate instability;
-
Exam for SLD
- Compartment
Contents
Pathologic Conditions
1
APL,
EPB
DeQuervain's Disease
2
ECRL,
ECRB
Tennis elbow
3
EPL
Rupture at Lister's tubercle
4
EDC,
EIP
Extensor Tenosynovitis
5
EDM
Rupture (rheumatoid)
6
ECU
Snapping at
ulnar styloid
